“Benign prostatic hyperplasia (BPH)”, is a common urological disease in which the prostate gland gets bigger without being cancerous. It mostly affects older men [1]. BPH makes people's quality of life very bad by causing annoying “Lower Urinary Tract Symptoms (LUTS)” like hesitation, nocturia, and incomplete bladder emptying [2]. BPH is becoming more common while the world's population is getting aged, which is putting a lot of stress on the economy and health care [3]. At first, medication can help with weak to moderate symptoms. However, surgery is needed for people whose symptoms don't get better, who have urinary retention, or who have complications [4].

Over the years, surgery methods for treating BPH have changed to provide the best symptom relief with the least amount of harm. Traditionally TURP has been seen as the gold standard because it effectively relieves obstructive symptoms [5]. There are still worries, though, about problems that can happen during surgery, like bleeding, TURS, and problems with sexual function [6]. As laser technology has improved, new methods have been created, such as HoLEP and PVP, which may be just as effective but have a lower risk of complications [7].

TUMT and PUL are two minimally invasive treatments that are becoming more popular because they are less invasive and require less time to heal [8]. But it's still not clear how well they work for people with bigger prostates or serious symptoms [9]. The goal of this retrospective research is to compare the safety and effectiveness of different surgery techniques used to treat BPH. This will help doctors figure out which method is best for each patient

This retrospective research analyzed medical records of subjects diagnosed with BPH who underwent surgical intervention between 2020-2023 at a tertiary care center. Inclusion criteria encompassed male subjects, diagnosed with BPH based on clinical evaluation, uroflowmetry, and imaging studies. Exclusion criteria included subjects with incomplete medical records or those lost to follow-up.

Surgical techniques analyzed in this research include “Transurethral Resection of The Prostate (TURP)”, “Holmium Laser Enucleation of the Prostate (HoLEP)”, “Photo Selective Vaporization of the Prostate (PVP)”, “Transurethral Microwave Thermotherapy (TUMT)”, and “Prostatic Urethral Lift (PUL)”. Data collected from medical records included demographic information, preoperative characteristics, perioperative parameters, and postoperative outcomes. Statistical analyses, including descriptive and inferential tests, were employed to compare outcomes among the different surgical modalities keeping p<0.05 as significant. Ethical approvals were procured.

Table 1 presents the baseline characteristics of the research cohort, revealing notable differences among the surgical techniques analyzed. subjects undergoing TURP tended to be younger, with slightly smaller prostate volumes and lower “International Prostate Symptom Score (IPSS)” compared to those undergoing HoLEP, PVP, TUMT, and PUL. These findings suggest variability in patient demographics across different surgical modalities, highlighting the importance of individualized treatment approaches in BPH management.

Table 1: Baseline Characteristics of research Cohort

Table 2 provides insights into perioperative outcomes associated with each surgical technique. TURP was associated with longer operative times and greater blood loss compared to minimally invasive procedures such as TUMT and PUL. Conversely, HoLEP demonstrated shorter hospital stays and decreased blood loss compared to TURP, suggesting potential advantages in terms of perioperative recovery. These findings underscore the need for careful consideration of perioperative parameters when selecting the appropriate surgical approach for subjects with BPH.

Table 2: Perioperative Outcomes

The comparative analysis of surgical techniques in managing BPH revealed notable differences in efficacy, safety, and perioperative outcomes. This research contributes valuable insights into the strengths and limitations of each surgical approach, assisting clinicians in personalized intervention selection. TURP has long been the gold standard for BPH due to its effectiveness in relieving obstructive symptoms. Current study’s findings align with previous research, showcasing significant improvements in IPSS and uroflowmetry parameters post-TURP. However, TURP is associated with perioperative complications like bleeding and TURS, alongside a longer hospital stay compared to minimally invasive procedures. Laser prostatectomy techniques, like HoLEP and PVP, offer comparable efficacy to TURP with potentially lower complication rates. HoLEP showed shorter hospital stays and reduced blood loss, while PVP demonstrated favorable perioperative parameters and symptom improvement [1-6]. Minimally invasive procedures like TUMT and PUL offer alternatives with reduced invasiveness and shorter recovery times. While TUMT showed satisfactory improvements in IPSS and uroflowmetry parameters, its efficacy may be limited in subjects with larger prostates. PUL offers a potential advantage in preserving sexual function. Comparative literature supports current study’s findings, emphasizing the need for patient-centered decision-making considering prostate size, patient preference, and comorbidities. Limitations include the retrospective design, potential selection bias, small sample size, and short-term follow-up [7-9]. Future research with larger, prospective cohorts and longer follow-up periods is essential to further clarify comparative effectiveness and long-term outcomes in BPH management.

In conclusion, current study’s comparative analysis provides valuable insights into the efficacy, safety, and perioperative outcomes of surgical techniques in the management of BPH. While TURP remains a reliable option, newer modalities such as laser prostatectomy and minimally invasive procedures offer promising alternatives with potentially improved safety profiles. Clinicians should consider patient-specific factors and preferences when selecting the most appropriate surgical approach, aiming to optimize treatment outcomes and patient satisfaction in BPH management.

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